Poster Session 1
Category: Clinical Obstetrics
Poster Session 1
Lital Shaham, MD, PhD (she/her/hers)
Resident Physician, Department of Obstetrics and Gynecology, Sheba Medical Center
Department of Obstetrics and Gynecology, Sheba Medical Center
Sheba Medical Center, HaMerkaz, Israel
Shiran Bookstein Peretz, MD
Resident
Sheba Medical Center, Ramat Gan, Israel
Ramat Gan, HaMerkaz, Israel
Michal Fishel Bartal, MD
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Michal Axelrod, MD, MPH (she/her/hers)
Sheba Medical Center
Sheba Medical Center, HaMerkaz, Israel
To compare maternal and neonatal outcomes between induction of labor (IOL) and planned cesarean delivery (CD) among nulliparous individuals of advanced maternal age (≥40 years).
Study Design:
We conducted a retrospective cohort study at a single tertiary center (2011–2025), including nulliparous women aged ≥40 years with singleton pregnancies ≥34 weeks who underwent IOL or planned CD. Individuals were excluded if they had a mandatory indication for CD (e.g., placenta previa, vasa previa, malpresentation) or experienced spontaneous labor onset or rupture of membranes. Primary outcomes included composite maternal adverse outcomes (CMAO: postpartum fever, hemorrhage, blood transfusion, ICU admission, prolonged hospitalization, or readmission) and composite neonatal adverse outcomes (CNAO: low Apgar, cord pH < 7.1, neonatal intensive care unit (NICU) admission, RDS, subgaleal hematoma, or TTN).
Results:
Of 653 eligible individuals, 359 (55.0%) underwent planned CD and 294 (45.0%) underwent IOL. Among those induced, 130 (44.2%) had an unplanned CD. Age >45 years (aOR 2.37, 95% CI 1.04–5.39, p=0.040) and severe preeclampsia (aOR 3.43, 95% CI 1.05–11.28, p=0.042) were independently associated with unplanned CD. CMAO occurred more often with IOL (19.4% vs. 9.5%, p< 0.001), including higher rates of postpartum fever (5.8% vs. 0.6%, p< 0.001), blood transfusion (5.1% vs. 0.8%, p=0.001), and longer hospitalization (3.5 vs. 0.9 days, p< 0.001). CNAO rates were similar after adjusting for gestational age (aOR 1.19, 95% CI 0.63-2.26, p=0.591), although Small for gestational age (31.3% vs. 16.4%, p< 0.001) and NICU admission (1.5% vs. 5.2%, p=0.01) differed.
Conclusion:
Nearly half of nulliparous ≥40 undergoing IOL required unplanned CD. Age >45 and severe preeclampsia were independent predictors. IOL was associated with higher maternal morbidity compared to planned CD. These findings support individualized counseling and a risk-stratified approach to delivery planning in advanced maternal age.